| NPI | 1699720342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IN 34002818A) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IN 87001509A) |
| 106H00000X Marriage & Family Therapist (Licence: IN 35001201A) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2025-06-10 |